Standardized training for healthcare professionals and its impact on patients with perennial rhinitis: a multi-centre randomized controlled trial (original) (raw)

2007, Clinical and Experimental Allergy

Background Perennial rhinitis is common and often results in substantial, potentially avoidable, impairment of quality of life. Quality of rhinitis care has been shown to be sub-optimal in general practice. Rigorous evaluation of educational interventions for healthcare professionals using randomized controlled trials is very uncommon.Objective To evaluate the effectiveness of standardized allergy training for healthcare professionals on patients' disease-specific quality of life.Methods Patients with clinician diagnosed perennial rhinitis and/or a prescription for relevant nasal medication were recruited from general practice. Following baseline measurement of quality of life using the validated rhino-conjunctivitis questionnaire (RQLQ), patients were centrally randomized to receive care from an allergy-trained primary healthcare professional or routine care. RQLQ was measured again at 13 months after randomization.Results Process measures revealed that the training was well received. 202 patients were included in the intention-to-treat analysis and 157 in the per-protocol analysis. There was a 0.23 greater mean improvement in quality-of-life scores in the intervention group when compared with controls (P=0.08) in the intention-to-treat analysis, this increasing to a 0.3 greater mean improvement if confined to a per-protocol analysis (P=0.05). The intention-to-treat analysis showed that 39/101 (39%) in the intervention group showed a clinically significant 0.5 improvement in RQLQ compared with 28/101 (28%) of controls (risk difference=11%, number needed to treat=9, P=0.1).Conclusions Standardized allergy education given to primary healthcare professionals leads to modest improvements in disease-specific quality of life in patients with perennial rhinitis.

Homeopathy for Allergic Rhinitis: A Systematic Review

THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE, 2017

Objective: The aim of this study was to evaluate the efficacy and effectiveness of homeopathic intervention in the treatment of seasonal or perennial allergic rhinitis (AR). Method: Randomized controlled trials evaluating all forms of homeopathic treatment for AR were included in a systematic review (SR) of studies published up to and including December 2015. Two authors independently screened potential studies, extracted data, and assessed risk of bias. Primary outcomes included symptom improvement and total quality-of-life score. Treatment effect size was quantified as mean difference (continuous data), or by risk ratio (RR) and odds ratio (dichotomous data), with 95% confidence intervals (CI). Metaanalysis was performed after assessing heterogeneity and risk of bias. Results: Eleven studies were eligible for SR. All trials were placebo-controlled except one. Six trials used the treatment approach known as isopathy, but they were unsuitable for meta-analysis due to problems of heterogeneity and data extraction. The overall standard of methods and reporting was poor: 8/11 trials were assessed as ‘‘high risk of bias’’; only one trial, on isopathy for seasonal AR, possessed reliable evidence. Three trials of variable quality (all using Galphimia glauca for seasonal AR) were included in the meta-analysis: nasal symptom relief at 2 and 4 weeks (RR = 1.48 [95% CI 1.24–1.77] and 1.27 [95% CI 1.10–1.46], respectively) favored homeopathy compared with placebo; ocular symptom relief at 2 and 4 weeks also favored homeopathy (RR = 1.55 [95% CI 1.33–1.80] and 1.37 [95% CI 1.21–1.56], respectively). The single trial with reliable evidence had a small positive treatment effect without statistical significance. A homeopathic and a conventional nasal spray produced equivalent improvements in nasal and ocular symptoms. Conclusions: The low or uncertain overall quality of the evidence warrants caution in drawing firm conclusions about intervention effects. Use of either Galphimia glauca or a homeopathic nasal spray may have small beneficial effects on the nasal and ocular symptoms of AR. The efficacy of isopathic treatment of AR is unclear.

The "physician on call patient engagement trial" (POPET): measuring the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis and asthma patients

International forum of allergy & rhinology, 2015

In this prospective, multicenter, randomized, controlled, double-blind study, we investigated the impact of a mobile patient engagement application on health outcomes and quality of life in allergic rhinitis (AR) and asthma patients. In total, 327 patients with diagnoses of persistent AR or mild-to-severe persistent asthma were randomized into 2 intervention groups and 2 control groups upon their admission at outpatient clinics. The intervention groups (POPET-AR and POPET-Asthma) received a mobile phone application ("physician on call patient engagement trial" [POPET]), enabling them to communicate with their physician, and record their health status and medication compliance. The AR groups completed the Rhinitis Quality of Life Questionnaire (RQLQ) at initiation and at the first month of the study. The asthma groups completed the Asthma Control Test (ACT) at initiation and at the third month of the study. The POPET-AR group showed better clinical improvement than the cont...

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